Vlad Budu1,2*, Tatiana Decuseară1, Andreea-Nicoleta Costache1, Lavinia Sava1, B Dima1 and M Tuşaliu1,2
1ENT Institute “Prof. Dr. D. Hociotă”, Bucharest, Romania
2University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
Received: 06 March, 2017; Accepted: 07 April, 2017; Published: 08 April, 2017
Vlad Budu, Associated Professor, ENT Institute, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania, Tel: +40788413218; E-mail:
Budu V, Decuseară T, Costache AN, Sava L, Dima B, et al. (2017) Tornwaldt’s Cyst – Comments on Clinical Cases. Arch Otolaryngol Rhinol 3(2): 032-34. DOI: 10.17352/2455-1759.000040
© 2017 Budu V, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Tornwaldt cyst; Endoscopic sinus surgery; Nasopharyngeal tumor
Tornwaldt’s cyst represents a benign tumor which develops in the midline of the nasopharyngeal mucosa. Due to the fact that it doesn’t usually cause any symptoms, it is often discovered incidentally during a nasal endoscopy or another imaging investigation (either CT or MRI). Treatment is only advised when the cyst becomes symptomatic. In this paper, the authors aim to illustrate the optimal approach when dealing with a Tornwaldt’s cyst and to underline the importance of a correctly executed endoscopic surgery.
Tornwaldt’s cyst is a benign nasopharyngeal structure that results from a developmental remnant and which may cause clinically significant symptoms. It is named after Gustav Ludwig Tornwaldt who established it as a pathological entity in 1885, despite being previously discovered by Mayer in 1840 during an autopsy.
The overall incidence of Tornwaldt’s cyst varies from one author to another. Therefore, whilst some authors report an incidence of 1.4% to 3.3% in autopsy specimens, others describe the cyst based on MRI findings ranging from 0.2% to 5% of the cases .
Generally speaking, a Tornwaldt’s cyst is an uncommon discovery, with no gender predilection, which may occur at any age, especially in the 2nd and 4th decades of life .
From an embryologic point of view, Tornwaldt’s cysts form as a result of the notochord retracting from its contact point with the endoderm of the primitive pharynx, as the former ascends through the clivus in order to create the neural plate. Therefore a persistent communication appears between the roof of the nasopharynx and the notochord.
There are two types of Tornwaldt’s cysts depending whether the orifice of the remnant is obstructed or not. Thus, the first type is described as cystic when the orifice is obliterated. Secondly, Tornwaldt’s cysts may appear as crusting when there are adhesions that do not close the orifice entirely . The cyst is lined by respiratory epithelium that may present areas of squamous metaplasia especially once it’s obstructed and it develops an inflammatory process.
Tornwaldt’s cyst is usually located in the midline of the posterior nasopharyngeal wall, but it may also be found slightly off midline, especially extending upwards and backwards toward the occipital bone. Therefore, Tornwaldt’s cyst lies posteriorly of the path taken by Rathke’s pouch as it descends from the sella turcica. By understanding this localization, we can easily enlist several differential diagnoses to rule out.
Most Tornwaldt’s cysts are small and asymptomatic, but they may develop symptoms as their volume increases due to mucous secretion. This happens either spontaneously or secondary to inflammation when edema of the orifice leads to further aggravation of the pathophysiological cycle (Figure 1).